Would the NHS fall apart without private providers?

The idea of running a private ambulance company occurred to me thanks to
my disgruntled father, who after 30 years’ frontline service as an NHS
Ambulance Technician, quit his job so we could start the business.

Our business is simple. We are paid by NHS Trusts to ship patients from
hospital to hospital, appointment to appointment. It’s the world of routine
transportation and it’s a slow grind, but a fine market for aspiring
entrepreneurs, especially those with knowledge of the market. Those who know
the NHS Ambulance Trusts are failing, for instance. Those who know that without
private ambulance companies, the entire NHS patient transport system would
grind to a halt.

The first private ambulance company sprang into existence just over 40
years ago, though it took a few years before the NHS would accept them. They
were met with animosity and distrust, and seen as unprofessional. The public
sector’s perception of the private as an unruly and unwanted infestation was -
and is - prevalent, and not altogether without reason.

The private ambulance sector might be an integral, even indispensible
service to the NHS, but it is and always has been flawed. Weak regulation means
it’s too easy for some to cut corners. The regulators the Care Quality
Commission (CQC) no doubt meet their quotas, but who sets their agenda? Who
regulates the regulator? On average, private ambulance companies are
spot-checked once every eighteen months, with inspections sometimes lasting no
more than a few hours. And like Ofsted inspections, they come with prior
notice.

The mismanagement of private ambulance companies by public regulatory
bodies breeds a lack of quality. It’s been so since the eighties. Though
business continues as usual, the blackened reputation of private firms fuels
the public-private rift. The rift will never disappear, but as the NHS and
private sector move closer together, with mergers and subcontracting on the
rise, better working relationships seems essential.

I spoke to Nigel Gardner, one of the country’s first private ambulance
bosses. He started Ambukare in 1984 with two others, Martin Claxton and Jeff
Barnett. His business snowballed quickly and informally. No paperwork, no CQC,
no fiery hoops; they were up and running within a week, working mainly for
private hospitals. It wasn’t until 1988 – four years after starting the company
– that Gardner transferred his first NHS patient. Gardner had served as an NHS
ambulance man for 20 years before going private, and when the Ambulance Service
went on strike in 1988, he was waiting in the wings.

“Patient movement froze. The NHS basically came begging”, he said.
“Patients needed moving, and we had the capacity to do it.”

NHS work came suddenly – and easily, too, as back then there was no
competition. As Gardner says: “There were so few of us, we were sharing out the
work.”

So what incentive was there to provide a quality service?

“Every incentive. I had my company’s reputation to uphold. The NHS guys
aren’t bothered about the patients. Their wages are secure whatever they do. I
know: I was one of them.”

He told how he paid to redecorate the hallway of a patient’s house after
one of his crews had accidentally scuffed the wallpaper with the stretcher.
It’s a novel example, but I understood his point. He added: “For routine work, private
is better. Smaller companies like mine were more responsive. Ambukare certainly
improved the county services because we did the jobs they weren’t doing. They
realised we could do things quicker and cheaper.”

Gardner’s corner-shop spirit epitomises the essence of small business.
But his is an isolated case, as much then as now. Gardner gave a more accurate
portrayal of the norm with a short tale about Richard Sage, a notorious conman
in the eighties and nineties.

Whilst working as a driver for an undertaker’s, Sage decided to set up
his own private ambulance firm. He did it convincingly too, embracing the
much-revered work-sharing ethic. He would take jobs from hospitals, demand
payment up front, and pass the jobs on to other companies. One of the companies
was Ambukare. Gardner received a call from an unfamiliar company, Inter County,
but obliged the request all the same. He then had a lengthy period of chasing
payment.

The undertaker’s firm hadn’t seen Sage for some time. Nor had any of his
clients. Eventually, Gardner decided to ring the police, who it turns out were
looking for him too. He was wanted for various acts of fraud. Gardner’s account
added another to the list.

The CID tracked him down in Spain.

“A lot of people were angry as Sage hadn’t paid a single client,” said
Gardner. “I knew I wouldn’t get my money back. I was just waiting to see what
the courts would do to him.”

The courts were firm, giving him several years, “which I suppose is only
fair”, Gardner laughs, “as we soon found out he’d been ferrying people around
in hearses!”

Dave Skidmore is GMB’s representative for South East Coast Ambulance
Service. He’s served 13 years as an NHS Ambulance Technician. He kindly gave me
an hour of his time to quiz him on small private ambulance firms.

He sounded despondent at times. An estimated £2.5 billion worth of
contracts emerged in the four months after April since new competition regulations
were passed. The regulation encourages Trusts to outsource and subcontract,
based largely on the theory that competition promotes great quality and better
service. The NHS is under threat like never before.

Skidmore said what distresses him is not just the threat to the NHS but
also the state of private companies and the nature of their agenda. “The whole
operation is fragmented”, he says. “We don’t know what they are doing.”

I remind him of the CQC, whose purpose it is to regulate the private
ambulance sector. That he knew very little about them speaks volumes. He said
the NHS needs to be more accountable, which he agreed should cover the CQC,
whose lack of accountability means private companies cut corners.

I relayed to him the story of Nigel Gardner, though I feared to mention
hearses, and I told him of my company. He expressed compassion for small
companies, though no doubt because minnows such as we, with fleets of
half-a-dozen, pose little-to-no threat. Our financial footprint on NHS budgets is
slight, which detaches us from his assertion that “private companies are cherry
picking all the profitable bits”, which he says “shows what they’re in it for”.
He told me the NHS is “left with all the bad bits.”

Nonetheless, it is private ambulance firms, small and large, that are
saving the NHS from greater embarrassment on a daily basis. When NHS patient
transport crews clock off at 5pm, which is the norm in large parts of the
country, the private companies sweep up. It’s out-of-hours work that is often outsourced,
and for a hospital left in the lurch with more patients than beds, private
companies are essential. “This is why”, Gardner says, “the NHS needs private
companies.”

If Skidmore had it his way, we would start the long march back from
privatisation tomorrow. “This business about the NHS being unsustainable and
unaffordable is a lie. It just isn’t funded properly.”

It’s difficult to imagine a trade unionist taking any other stance than
this. Likewise, it’s difficult to imagine Gardner varying in opinion either.

That private ambulance companies are plugging the gap is the
reality. It's old news to Skidmore, but is something he says the public are
being kept in the dark about. With greater awareness, he says, the small
players have a better chance of fighting off the big boys. At present, though,
there is a gap in the market, and no matter what flaws persist or what cherry
picking of contracts; there is room for two here.

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